Department of Epidemiology and Public Health, University College London, London, UK.
Glob Public Health. 2009;4(6):546-60. doi: 10.1080/17441690701727850.
Control and reduction of infectious diseases is a key to attaining the Millennium Development Goals. An important element of this work is the successful immunisation, especially in resource-poor countries. Mass immunisation, most intensively in the case of eradication, depends on a combination of reliable demand (e.g. public willingness to comply with the vaccine protocol) and effective supply (e.g. robust, generally state-led, vaccine delivery). This balance of compliance and enforceability is, quintessentially, socio-political in nature - conditioned by popular perceptions of disease and risk, wider conditions of economic development and poverty, technical aspects of vaccine delivery, and the prevailing international norms regarding power relations between states and peoples. In the past 100 years, three out of six disease eradication programmes have failed. The explanations for failure have focused on biotechnical and managerial or financial issues. Less attention is paid to socio-political aspects. Yet socio-political explanations are key. Eradication is neither inherently prone to failure, nor necessarily doomed in the case of polio. However, eradication, and similar mass immunisation initiatives, which fail to address social and political realities of intervention may be. A comparison of the smallpox and polio eradication programmes illustrates the importance of disease-specific socio-political analysis in programme conceptualisation, design, and management.
传染病的控制和减少是实现千年发展目标的关键。这项工作的一个重要内容是成功地进行免疫接种，特别是在资源匮乏的国家。大规模免疫接种，尤其是在根除的情况下，取决于可靠的需求（例如公众愿意遵守疫苗接种方案）和有效的供应（例如强大的、通常由国家主导的疫苗供应）的结合。这种合规性和执行力的平衡从本质上讲是社会政治性质的，取决于人们对疾病和风险的普遍看法、更广泛的经济发展和贫困状况、疫苗接种的技术方面以及关于国家和人民之间权力关系的现行国际规范。在过去的 100 年中，六个疾病根除计划中有三个失败了。失败的原因主要集中在生物技术、管理或财务问题上。对社会政治方面的关注较少。然而，社会政治解释是关键。根除本身既不容易失败，也不一定注定会失败，就像脊髓灰质炎那样。然而，根除以及类似的大规模免疫接种计划，如果不能解决干预的社会和政治现实，可能会失败。对天花和脊髓灰质炎根除计划的比较说明了在方案概念化、设计和管理中进行特定疾病的社会政治分析的重要性。
